Effectiveness of adherence to lipid lowering therapy on LDL-cholesterol in patients with very high cardiovascular risk: A real-world evidence study in primary care

Valeria Guglielmi, Alfonso Bellia, Serena Pecchioli, David Della Morte, Damiano Parretti, Iacopo Cricelli, Gerardo Medea, Paolo Sbraccia, Davide Lauro, Claudio Cricelli, Francesco Lapi

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background and aims Despite management guidelines advocating statin/ezetimibe use in very high cardiovascular risk (CV) conditions, adherence to this therapy is still suboptimal and LDL-C target attainment unsatisfactory. We aimed to investigate the level of adherence to statin/ezetimibe and LDL-C target achievement rates in an unselected very high CV risk population in primary care setting in Italy. Methods We performed a retrospective population-based study using the Health Search IMS Health Longitudinal Patient Database (HSD), including adult patients at very high CV risk, newly treated with statin, ezetimibe or their combination, with 3 and 6 months of follow-up. Results Although the large majority of patients had previous major CV events (99.9%), only 61% and 55.14% resulted adherent (Proportion of Days Covered, PDC≥80%) after 3 and 6 months, respectively. High adherence entailed almost a three times higher probability to reach the therapeutic LDL-C target (3 months: OR = 2.26 [95% [CI]: 1.88 to 2.72]; 6-months: OR = 2.74 [95% CI: 2.27 to 3.31]). The odds to treat to LDL-C target was greater for simvastatin-ezetimibe fixed combination, simvastatin, atorvastatin and rosuvastatin, in decreasing order. Finally, poor adherence was slightly more prevalent among patients treated with less effective statins, and at both low and maximal dosage regimens. Conclusions This population-based study showed that adherence to statin therapy is poor even among patients who have already experienced a CV event. Failure to achieve recommended LDL-C levels appears imputable to the use of moderate doses and low to standard efficacy statins.

Original languageEnglish (US)
Pages (from-to)36-41
Number of pages6
JournalAtherosclerosis
Volume263
DOIs
StatePublished - Aug 1 2017
Externally publishedYes

Fingerprint

Hydroxymethylglutaryl-CoA Reductase Inhibitors
LDL Cholesterol
Primary Health Care
Lipids
Therapeutics
Population
Health
low density lipoprotein inhibitor
Italy
oxidized low density lipoprotein
Databases
Guidelines
Ezetimibe

Keywords

  • Adherence to statins
  • Cholesterol
  • High cardiovascular risk
  • Lipid lowering drugs
  • Low density lipoproteins
  • Primary care

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Effectiveness of adherence to lipid lowering therapy on LDL-cholesterol in patients with very high cardiovascular risk : A real-world evidence study in primary care. / Guglielmi, Valeria; Bellia, Alfonso; Pecchioli, Serena; Della Morte, David; Parretti, Damiano; Cricelli, Iacopo; Medea, Gerardo; Sbraccia, Paolo; Lauro, Davide; Cricelli, Claudio; Lapi, Francesco.

In: Atherosclerosis, Vol. 263, 01.08.2017, p. 36-41.

Research output: Contribution to journalArticle

Guglielmi, Valeria ; Bellia, Alfonso ; Pecchioli, Serena ; Della Morte, David ; Parretti, Damiano ; Cricelli, Iacopo ; Medea, Gerardo ; Sbraccia, Paolo ; Lauro, Davide ; Cricelli, Claudio ; Lapi, Francesco. / Effectiveness of adherence to lipid lowering therapy on LDL-cholesterol in patients with very high cardiovascular risk : A real-world evidence study in primary care. In: Atherosclerosis. 2017 ; Vol. 263. pp. 36-41.
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abstract = "Background and aims Despite management guidelines advocating statin/ezetimibe use in very high cardiovascular risk (CV) conditions, adherence to this therapy is still suboptimal and LDL-C target attainment unsatisfactory. We aimed to investigate the level of adherence to statin/ezetimibe and LDL-C target achievement rates in an unselected very high CV risk population in primary care setting in Italy. Methods We performed a retrospective population-based study using the Health Search IMS Health Longitudinal Patient Database (HSD), including adult patients at very high CV risk, newly treated with statin, ezetimibe or their combination, with 3 and 6 months of follow-up. Results Although the large majority of patients had previous major CV events (99.9{\%}), only 61{\%} and 55.14{\%} resulted adherent (Proportion of Days Covered, PDC≥80{\%}) after 3 and 6 months, respectively. High adherence entailed almost a three times higher probability to reach the therapeutic LDL-C target (3 months: OR = 2.26 [95{\%} [CI]: 1.88 to 2.72]; 6-months: OR = 2.74 [95{\%} CI: 2.27 to 3.31]). The odds to treat to LDL-C target was greater for simvastatin-ezetimibe fixed combination, simvastatin, atorvastatin and rosuvastatin, in decreasing order. Finally, poor adherence was slightly more prevalent among patients treated with less effective statins, and at both low and maximal dosage regimens. Conclusions This population-based study showed that adherence to statin therapy is poor even among patients who have already experienced a CV event. Failure to achieve recommended LDL-C levels appears imputable to the use of moderate doses and low to standard efficacy statins.",
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T1 - Effectiveness of adherence to lipid lowering therapy on LDL-cholesterol in patients with very high cardiovascular risk

T2 - A real-world evidence study in primary care

AU - Guglielmi, Valeria

AU - Bellia, Alfonso

AU - Pecchioli, Serena

AU - Della Morte, David

AU - Parretti, Damiano

AU - Cricelli, Iacopo

AU - Medea, Gerardo

AU - Sbraccia, Paolo

AU - Lauro, Davide

AU - Cricelli, Claudio

AU - Lapi, Francesco

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Background and aims Despite management guidelines advocating statin/ezetimibe use in very high cardiovascular risk (CV) conditions, adherence to this therapy is still suboptimal and LDL-C target attainment unsatisfactory. We aimed to investigate the level of adherence to statin/ezetimibe and LDL-C target achievement rates in an unselected very high CV risk population in primary care setting in Italy. Methods We performed a retrospective population-based study using the Health Search IMS Health Longitudinal Patient Database (HSD), including adult patients at very high CV risk, newly treated with statin, ezetimibe or their combination, with 3 and 6 months of follow-up. Results Although the large majority of patients had previous major CV events (99.9%), only 61% and 55.14% resulted adherent (Proportion of Days Covered, PDC≥80%) after 3 and 6 months, respectively. High adherence entailed almost a three times higher probability to reach the therapeutic LDL-C target (3 months: OR = 2.26 [95% [CI]: 1.88 to 2.72]; 6-months: OR = 2.74 [95% CI: 2.27 to 3.31]). The odds to treat to LDL-C target was greater for simvastatin-ezetimibe fixed combination, simvastatin, atorvastatin and rosuvastatin, in decreasing order. Finally, poor adherence was slightly more prevalent among patients treated with less effective statins, and at both low and maximal dosage regimens. Conclusions This population-based study showed that adherence to statin therapy is poor even among patients who have already experienced a CV event. Failure to achieve recommended LDL-C levels appears imputable to the use of moderate doses and low to standard efficacy statins.

AB - Background and aims Despite management guidelines advocating statin/ezetimibe use in very high cardiovascular risk (CV) conditions, adherence to this therapy is still suboptimal and LDL-C target attainment unsatisfactory. We aimed to investigate the level of adherence to statin/ezetimibe and LDL-C target achievement rates in an unselected very high CV risk population in primary care setting in Italy. Methods We performed a retrospective population-based study using the Health Search IMS Health Longitudinal Patient Database (HSD), including adult patients at very high CV risk, newly treated with statin, ezetimibe or their combination, with 3 and 6 months of follow-up. Results Although the large majority of patients had previous major CV events (99.9%), only 61% and 55.14% resulted adherent (Proportion of Days Covered, PDC≥80%) after 3 and 6 months, respectively. High adherence entailed almost a three times higher probability to reach the therapeutic LDL-C target (3 months: OR = 2.26 [95% [CI]: 1.88 to 2.72]; 6-months: OR = 2.74 [95% CI: 2.27 to 3.31]). The odds to treat to LDL-C target was greater for simvastatin-ezetimibe fixed combination, simvastatin, atorvastatin and rosuvastatin, in decreasing order. Finally, poor adherence was slightly more prevalent among patients treated with less effective statins, and at both low and maximal dosage regimens. Conclusions This population-based study showed that adherence to statin therapy is poor even among patients who have already experienced a CV event. Failure to achieve recommended LDL-C levels appears imputable to the use of moderate doses and low to standard efficacy statins.

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KW - Cholesterol

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KW - Lipid lowering drugs

KW - Low density lipoproteins

KW - Primary care

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